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Background: Our understanding of breast shape and size changes after surgery is limited by a lack of measurement studies that evaluate and compare changes in breast dimensions after cosmetic breast procedures. This study was undertaken to remedy this deficiency.

Methods: Women undergoing primary vertical mastopexy, augmentation/mastopexy, and reduction were evaluated prospectively from 2002 to 2012. Breast augmentation patients were also measured prospectively over a 6-month period during the study. A total of 196 consecutive patients meeting the inclusion criteria—at least 3 months’ follow-up and no subsequent breast surgery—were evaluated (inclusion rate, 88.3 percent).

Results: Both nipples were located at or above the level of maximum preoperative breast projection in 60 percent of women presenting with ptosis. The maximum preoperative nipple displacement was 6.5 cm. All four procedures increased breast projection and upper pole projection, with a significantly greater boost when implants were combined with mastopexy (p < 0.01). Breast augmentation lowered the lower pole level (p < 0.001) and minimally elevated the breast mound, with no change in nipple level. Vertical mastopexy and reduction elevated the lower pole and breast mound, reduced areola size, and increased the breast parenchymal ratio (p < 0.001).

Conclusions: Vertical mammaplasty corrects glandular sagging and provides a modest increase in breast projection and upper pole projection. Augmentation/mastopexy most effectively treats upper pole deflation and ptosis. In ptosis, the nipple descends primarily with the breast, not on it. Nipple repositioning (<6.5 cm) is preferred over transposition to avoid overelevation and improve safety.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Leawood, Kan.

From the Swanson Center.

Received for publication August 27, 2012; accepted November 20, 2012.

Disclosure:The author has no financial interests to disclose. This study received no outside funding.

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David H. Song, M.D., M.B.A. is the President-elect of the American Society of Plastic Surgeons (ASPS). He is a consultant with BioMet, Emmi Solutions, LLC, a consortium-member providing senior debt for Brava, and consultant with and investor in HealthEngine.com. He receives author royalties from Elsevier. Scot Glasberg, M.D. is the President of the American Society of Plastic Surgeons (ASPS). He is a consultant with LifeCell Corp and Mentor Corp and an investor with Strathspey Crown. The authors have no sources of funding to report related to the writing or submission of this discussion.

The location and affiliation information should read as follows: Arlington Heights, Ill. From the American Society of Plastic Surgeons/Plastic Surgery Foundation.